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A 21-year-old man presents to the ED. He has a known history of type 1 diabetes. He is hypotensive with BP of 95/65 mm Hg, tachycardic at 120 beats per minute, and tachypneic at 30 breaths per minute.

A 21-year-old man presents to the ED. He has a known history of type 1 diabetes. He is hypotensive with BP of 95/65 mm Hg, tachycardic at 120 beats per minute, and tachypneic at 30 breaths per minute. Laboratory results reveal a WBC 20,000/μL, hematocrit 45%, platelets 225/μL, sodium 131 mEq/L, potassium 5.3 mEq/L, chloride 95 mEq/L, bicarbonate 5 mEq/L, BUN 20 mg/dL, creatinine 0.9 mg/dL, and glucose 425 mg/dL. Arterial blood gas reveals a pH of 7.2. Urinalysis reveals glucosuria and ketosis. There is a fruity odor to his breath. Which of the following provides the strongest evidence for the diagnosis?

a. Hypotension, tachycardia, and tachypnea

b. Glucose of 425 mg/dL, ketosis, and leukocytosis

c. Glucose of 425 mg/dL, ketosis, pH 7.2, and bicarbonate of 5 mEq/L

d. Glucose of 425 mg/dL, hypotension, and fruity odor to breath

e. Glucosuria, hypotension, and leukocytosis

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